Metformin: Is it worth it?

BY LEE RICE, DO, FAASM, FAAFP

Many of you have asked me to render my opinion on the disease preventive aspects of Metformin, a widely prescribed drug to control high blood sugar. I’ve kept you waiting so I could check in with my buddy Mark Moyad, M.D. Mark is a researcher who constantly scans the world’s clinical literature on supplements and cancer treatments. Metformin is one of those medications being studied for the treatment of other diseases.

In the last several years, there have been a number of studies evaluating metformin at least in part for its potential as an anti-cancer, anti-cardiovascular disease, anti-dementia and anti-aging drug.  As one would expect, it took no time for the lay press and many pseudo-scientists to advocate everyone taking it for everything from increasing libido, to preventing chronic disease, to increasing longevity in otherwise healthy people.

Additionally, Dr. Nir Barzilai, the Director of the Institute on Aging Research at the Albert Einstein College of Medicine, announced eagerly that he’s conducting an unusual clinical trial to test whether metformin can extend life, prevent cancer, heart disease and dementia.  The study is nicknamed “TAME”, (Targeting Aging with Metformin).  It will be at least 5 years before the results of that study are published, and if positive, metformin will be the medication approved by the FDA for this type of prevention.  His  philosophy is that it’s better to target the aging process itself as opposed to the individual diseases that cause premature death individually.  Makes sense, at least in theory.

I’ve been using metformin for at least 5 years in some patients following treatment for prostate cancer, primarily using Mark’s recommendation based on several studies that indicated it can be effective in preventing cancer recurrence in prostate and breast cancer patients.  This apparently has been due to its effectiveness in improving insulin sensitivity, decreasing inflammation and aiding in weight loss. So the question is: is it smart for healthy people roll the dice by taking metformin on the hope that it can improve life quality and enhance chances for longevity without chronic disease?  If there were no risks or significant side effects, it would be an easy answer.  However, it’s not without risk.

While the most serious side effects of metformin are:

  • lactic acidosis
  • megaloblastic anemia
  • liver toxicity

Less dangerous, but most commonly annoying side effects are diarrhea, nausea, abdominal discomfort, headache and muscle aches.  (Most of these may be lessened by taking very low doses with meals).  Metformin can also lower blood levels of B12 and magnesium, which can adversely affect many of our normal physiologic systems. This should give practitioners pause to consider if there might be a better solution for their patients.

In a recent talk Dr. Moyad pointed out that the study to date yielding the most promising results for metformin, actually showed that the positive results in the metformin arm were beaten by a significant amount by aggressive lifestyle changes that included weight loss, exercise and healthy nutrition.

Lifestyle was almost twice as  effective than metformin alone.

Here’s what Dr. Moyad had to say:

‘”The trial that made metformin a billion-dollar drug was called the Diabetes Prevention Trial. It showed that within three years patients in one arm (of the study) on metformin who weren’t even diabetics, they were prediabetics, reduce their risk of getting diabetes by 31% and it made every newspaper.  But, there was a third arm in that trial; it was a lifestyle group that exercised 150 minutes per week. They cut back on about 450 calories a day. They lost about 7% of their body weight, and in that group there was a 58% reduction. It significantly beat metformin in the head-to-head trial, and both beat placebo, and people still walk out of that trial thinking metformin, when they should be thinking intensive lifestyle changes beat the drug.

Lifestyle changes beat the drug–that’s newsworthy. So here’s my advice. For healthy people without disease or major risk factors, the best choice that has the greatest probability of positive results and the least risk is LIFESTYLE. Aggressive lifestyle management has ZERO risk and MAJOR risk benefits across the board.  It’s just harder to do. What do I say to that? Do it anyway!
I’ve copied the talk given by Mark recently if you are interested in reading his more encompassing thoughts…click here.
So here it is in a nutshell…Eat some broccoli and blueberries today. Take a walk or jog around the block and practice some forgiveness. Give gratitude a try and meditate or pray for 10 minutes before you sleep so you can rack up a solid 8 hours of snooze time. That’s what we call aggressive lifestyle management.

If you are interested in reading more of Dr. Moyad’s encompassing thoughts from his recent talk…click here.

Cheers,
Lee